Overview

1. Optimizing Information Technology Course Three - March 11 Presented by Patrick Gauthier Overview

2. Health IT Definitions Health IT Vision and Reality Importance of IT Planning Essentials of Implementation Process Re-Design – First, Get Better Basic Self-Assessment & Stages of Change – Get Real Barriers to Change – Get with it! Learning Objectives

3. What is the Role of Health IT?How can IT be “Optimized”? Productivity Quality Tool Data Analysis Process Project Audit Reporting Efficiency Any Silver Bullets? Access to Records

4. We’re in Good Company 2008 Data

5. First…some definitions HEALTH INFORMATION TECHNOLOGY (HIT) - Information processing using both computer hardware and software for the entry, storage, retrieval, sharing, and use of health care information. Two common components of HIT are electronic medical records and computerized physician order entry. ELECTRONIC HEALTH RECORD (EHR) - In health informatics, an electronic health record refers to the subset of a patient's electronic medical record (EMR) that is integrated into a larger information network and owned by the patient. In common usage, EHRs and EMRs are used interchangeably to refer to a patient's medical record in digital format. Efforts are underway to develop consensus definitions for these terms and others. ELECTRONIC MEDICAL RECORD (EMR) - An electronic medical record refers to a patient's legal medical record, stored in digital format. It serves as a repository for clinical data and may have additional capacities such as computerized physician order entry (CPOE) and clinical decision support. Efforts are underway to develop consensus definitions for this term and others.

6. More Definitions HEALTH INFORMATION EXCHANGE (HIE) - Health information exchange is defined as the mobilization of healthcare information digitally across organizations within a region or community. HIE provides the capability to move clinical information between separate health care information systems while maintaining the meaning of the information being exchanged. INTEROPERABILITY - The ability of different information technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use the information that has been exchanged.

7. More Definitions PERSONAL HEALTH RECORD (PHR) - A PHR is a health record that is "owned" and maintained by an individual patient, rather than by payers or providers. Though the term has been around for several decades, it has recently received renewed attention with the adoption of electronic health records. REGIONAL HEALTH INFORMATION ORGANIZATION (RHIO) - A RHIO is a multi-stakeholder organization, operating in a specific geographical area, that enables the exchange and use of health information, in a secure manner, for the purpose of promoting the improvement of health quality, safety and efficiency. Officials from the U.S. Department of Health and Human Services see RHIOs as the building blocks for the National Health Information Network (NHIN). When complete the NHIN will provide universal access to electronic health records.

8. More Definitions NATIONAL HEALTH INFORMATION NETWORK (NHIN) - The technologies, standards, laws, policies, programs and practices that enable health information to be shared among health decision makers, including consumers and patients, to promote improvements in health and health care. The vision for the NHIN is said to have begun in 1991 with the publication of an Institute of Medicine report, "The Computer-Based Patient Record." The path to a national network of health care information is through the successful establishment of regional health information organizations. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY (ONC) - Provides counsel to the secretary of the U.S. Department of Health and Human Services and others within the department for the development and nationwide implementation of an interoperable health information technology infrastructure. The ONC also provides management of and logistical support for the American Health Information Community (AHIC).

9. Transformational Role of IT Generally… Leads to safer health care by eliminating duplicate services and identifying unsafe practices Supports higher quality care by virtue of access to records and measure of outcomes Provides cost savings in the way of reduced consumption and improved outcomes Where providers are concerned… Eliminate waste and variation in operations Collect, analyze and report data Standardize, normalize and develop data dictionary Skill building potential Differentiate and innovate

10. The Vision Paperless, accessible, accurate, and reliable Improved coordination of care, transitions and communication Administrative simplification Improved analytical and reporting capabilities Ability to make management decisions based on valid data Streamlined processes and automated workflow Improved revenue and productivity Alleviate access and capacity issues Enable integration, Shared Decision-Making, Predictive Modeling, and Population Health Mgmt.

11. Reality It can take much longer and be more expensive than you expected to truly implement a system CCHIT certification (EHR and Meaningful Use) is very important Security and privacy are more important now than ever Difficult to balance what makes you unique with what vendors have to offer Tailoring and customizing software is expensive Hosting software and hardware is expensive Software contracts are difficult to negotiate Automating poor business process and inefficient workflow leads to faster breakdowns Training is often totally under-estimated Some vendors will be acquired and some may go out of business. Ongoing support is an issue.

12. Optimizing IT Investments

13. IT Planning Form an EHR Committee with Executive Sponsorship Conduct strategic IT planning Adopt a 12-24 month timeline Conduct Needs Assessment: type and size of facilities, specialties, core processes and documentation preferences Develop budget (Total Cost of Ownership) Expect professional Project Management Gather all forms and “work-around” tools in use Conduct business process analysis among core processes (registration, assessment, treatment planning, billing, etc.) Identify process quality and efficiency improvements Document business rules and data definitions Document technical, functional, reporting and financial requirements If you don’t know, ask for help

14. IT Planning Solicit proposals that address standards, CCHIT certification, hardware, ASP (SaaS) options, networking, and support/maintenance Ask for “live” installation references Conduct reference checks and conduct onsite observation Develop use-case script for vendor demos to control scenario Compare at least 3 vendors Evaluate and score each objectively with a scoring tool Negotiate contract terms including support and upgrades Coordinate purchase and installation of all hardware Coordinate purchase and installation of all software

15. IT Planning Consider the addition of an Independent Verification and Validation (IV&V) consultant and/or a Project Management Professional (PMP) for the duration of your implementation Establish implementation plan and enforce accountability Establish comprehensive training program Develop Risk Management Plan to mitigate against risk of dissatisfaction, vendor failure, product transition or “cut-over” problems, and changes to regulatory matters pertaining to security, interoperability, etc. Test, validate, verify, rinse and repeat before “going live” Test data exchange with payers (EDI) 837 Health Care Claims 835 Payment Advice 270/271 Health Care Benefit Inquiry and Response 276/277 Claim Status Request and Response 278 Health Care Services Request for Review

16. Project Charter, Team, Planning and Communication Product/Process Alignment System Configuration Testing and Data Quality Assurance Training Go-Live Review, Learn, and Improve Seven Essentials ofImplementation

17. Agreement on: • Purpose • Mission • Shared Beliefs and Values • Strategy • Core Processes • Definition of: • Process Ownership • Process Objectives • Targets • Key Performance Indicators (KPI) + Qualitative Quantitative Process Optimization Processes Performance Business System Starting Point

18. Importance of Workflow Analysis Provides: Unbiased view of the entire business process Congruence between Operations and Policy Model for Determining: Process Improvements Future Requirements Missing Functions Enterprise Integration People Processes Technology

19. Process Mapping or Flow Charting? Mapping • Sequence of events • Decision points • Controls • Responsibilities • Information / systems required • Results and records obtained Flow Charting • Sequence of events

20. Process Mapping Records Information Process Responsibility Person Doc.1 No Record 1 Person Yes Person Doc.2 Person No Doc.3 Person Yes Record 2 Person End

21. Mapping Processes • Map process as currently occurs, including problems • Identify risks and barriers associated with the process • Mitigate risks and barriers associated with the process • Identify opportunities for improvement / efficiency • Map optimized process • Keep record / evaluation of improvements made

22. Common Symbols

23. Process Analysis • A process map visibly displays complex processes in a way that is easily understood • Answers key questions: • Who is the process owner? • Which “actors” are involved? • What transpires end-to-end? • What decisions are made? • What business rules govern the process? • What info / data is needed / produced? • Where is the information stored? • From this map, mitigating steps can be designed to eliminate risks, gaps and barriers • From this map, time studies can be conducted to find efficiencies

24. HIT Readiness Self-Assessment Score of 65 or lower? Pause and seek guidance before proceeding

25. Levels of Readiness Level 1 – Contemplation Level 2 – Due Diligence / Vendor Evaluation Level 3 – Negotiating a Contract Level 4 – Implementation Planning Level 5 – Initial “Go Live” Level 6 – Meaningful Use 6 Level 5 Level 4 Level 3 Level 2 What level are you at? Skipping any steps? Level 1

26. To Host or Not to Host Does your organization have the capacity to manage a sophisticated IT infrastructure including: Staff? Servers? Network? Software training? Upgrades and “patches”? Change Management? If not, consider an ASP (application service provider) or SaaS (software as a service) option.

27. Meaningful Use The use of a certified EHR in a meaningful manner (e.g.: e-Prescribing); The use of certified EHR technology for electronic exchange of health information to improve quality of health care; and The use of certified EHR technology to submit clinical quality and other measures.

28. HITECH Act Incentives EHR incentives are available only to certified eligible providers and hospitals demonstrating meaningful use of certified EHR systems On June 24, 2010, ONC published a final rule to establish a temporary certification program for health information technology. Several Authorized Testing and Certifying Bodies (ATCB) will be approved by ONC to certify systems

29. Choosing a Vendor Most leading products are quite capable. Choice should involve “environmental” factors: CCHIT Certification Track-Record Reputation among your peers (local demands and variable requirements) Proven off the shelf interfaces (verify with RHIO partners) Proven reporting capability (verify with State and payers) Competitors / Peers Don’t be the first among your friends with a new vendor Talk to other like organizations and learn from their experiences Available financial and implementation support Hospitals / systems of care Associations

30. Our Destination The Cloud

31. Organizational culture, beliefs, and values as well as resistance to the concept of change among clinicians (however ironic) Management style, competing priorities and capacity constraints Various forms of tension Failure to secure staff buy-in and/or executive sponsorship Lack of accountability Budget / Total Cost of Ownership 6 Big Barriers

32. Put Things Into Perspective… In 10 years time, things will change EHR technology will have improved exponentially Use of EHR technology will be universal and mandated Data will be widely shared You may have a different EHR vendor You will certainly have replaced all your current hardware Some things will remain the same Many of your staff Many of your patients This is an investment in your organization, your staff, and your patients

33. Change “Given the costs and waste in our healthcare system, redesign may be our only sustainable route to justice and financial solvency.” “If everyone is thinking alike, nobody is thinking” “Culture eats strategy for breakfast” “We cannot solve our problems with the same kind of thinking we used in creating our problems”

34. Thank You! Questions? Patrick Gauthier Director pgauthier@ahpnet.com 888-898-3280 x.802 www.ahpnet.com